10/29/2026
BANGERS & MASH
Case 001 | Immediate Implants & Internal Sinus Grafting
One surgery. Two implants. Targeting restoration at eight weeks.
Welcome to Bangers & Mash, an educational series from Spokane Oral Surgery featuring implant successes, complications, and the lessons learned along the way. Some images may be graphic.
This patient presented with a compromised upper right molar requiring sectioning of an existing bridge and extraction of tooth #3, along with implant placement at the adjacent #4 site.
We combined multiple procedures into a single surgical visit:
Sectioning of the existing bridge and extraction of #3 with immediate implant placement
Simultaneous implant placement at site #4
Internal sinus grafting at #3 using vertical rotary osteotomes
Digitally planned, dynamically navigated implant placement using X-Guide
Primary stability was excellent at both sites:
Site #3: 57 Ncm insertion torque, despite simultaneous internal sinus grafting
Site #4: 45 Ncm insertion torque
With conventional staged treatment, extraction, healing, sinus augmentation, implant placement, and restoration can sometimes extend over many months, potentially 8–12 months in more complex cases.
Our goal is to have this patient ready for restoration at approximately eight weeks, provided healing and osseointegration progress as expected. The final photo is our patient at 2 weeks post op.
The Takeaway
Not every patient requires a staged approach. With appropriate case selection, advanced surgical techniques, and precise digital planning, procedures that traditionally require multiple surgeries can sometimes be completed in a single surgical visit.
Excellent primary stability at both implant sites supports our planned accelerated restorative timeline.
The objective isn't simply faster treatment. It's predictable outcomes, fewer surgeries, and a better patient experience.
Spokane Oral Surgery
We're here to help.
Dr. Nicholas Freuen DDS MD
Owner/Founder of Spokane Oral Surgery
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